Doctors in the dark
Thank you for publishing Donuts for Doctors by Alan Cassels (September 2005). As a family physician in the states, I, and other primary-care physicians, have had to practise with psychiatric consultants advising us, and who, because of the pharmaceutical industry’s influence at the university level, are basically without any up-to-date knowledge of the various medical disorders that can present as depression. Therefore, we were incorrectly taught how to work up patients with the symptoms that would typically be identified as depression. The literature that was produced for us to study, typically funded by the pharmaceutical industry with the blessing of the licensing boards, did not cover new developments from the ‘80s and ‘90s, in the differential diagnosis of illnesses presenting with the symptom complex that is generically called “depression.” Many cases of sleep deprivation were, and continue to be, misdiagnosed, and people are inappropriately given antidepressants and anti-psychotics.
Physicians, who complain about this inappropriate influence, and/or actually make a concerted effort to find other disorders masquerading as “depression,” can be harassed by licensing boards. This, in fact, happened to me when a forensic psychiatrist on the Texas State Board of Medical Examiners presided over a session where I was considered incompetent because I was diagnosing more than 10 percent of my patients with obstructive sleep apnea. The forensic expert noted that she didn’t really know anything about obstructive sleep apnea.
Last October, Chest, an internationally respected medical journal, published a study demonstrating that about 35 percent of the patients in a US primary care practice had obstructive sleep apnea, typically undiagnosed. Unfortunately, persons with mild, or severe sleep apnea, have a significantly increased risk for motor vehicular accidents, heart attacks, strokes, and behavioural issues resulting in psychiatric diagnoses; criminal charges may result 10 percent of the time. There has not been any research into sleep disorders presenting as a preventable cause of crime. I believe this is another result of the pharmaceutical industry’s financial power over medical education and research.
This issue applies to Canada in that physicians are being pressured to follow clinical guidelines. Who writes the clinical guidelines? In the states, 90 percent of the physicians participating in writing these guidelines have pharmaceutical industry conflicts of interest. Maybe it is time to pressure the government to fully fund physician education with tax revenues, instead of allowing pharmaceutical money to be strewn about. That may be the most important way to reduce the high cost of medical care. Most physicians would gladly give competent scientific and cost effective care – if they only knew what that was.

Cynthia Jeanne Lee, MD

Cure worse than cancer
Thank you so much for your article Donuts for Doctors. In my opinion, it is not that more people are depressed, but more that life is hard, and for many, getting harder. It is natural to be depressed sometimes, and there are many ways to protect yourself from letting those moments control your life. I have seen many people, including professionals, suffer greatly from bad reactions to many different drugs, Paxil among them. My late father became almost unrecognizable as he was dying from a brain tumour, the last cancer after endless rounds of chemo, radiation, and surgery for colon cancer. By the time he died, he had colon, lung, eye, and brain cancer. I believe the steroid drugs increased his personality changes as much as the tumour itself.
Were he alive, Terry Fox would be horrified at the lack of meaningful progress in cancer care. Millions spent on not much that is of any use to the average patient, as far as I can see. I have seen many people drugged incapable and stupefied, and our system has taken to forcing drugs on anyone labelled with certain illnesses. It is unbelievable. As well as the profit-making pharmaceutical industry’s lack of any credibility, we see people forced to take bad drugs to keep their drivers’ licences, or even their freedom. Shame on them.

C.P. Drew

Cooperation our only alternative
What a great pleasure to read some of my own long-held ideas articulated so masterfully in Geoff Olson’s recent article Kropotkin vs. Darwin (September 2005). This happens almost every time I read Olson’s work. I have long been disturbed by the pervasive emphasis on violence as the basic driving force in nature from the Darwinist camp, and the blatant dearth of examples in the media of the more prevalent components of cooperation and collaboration in the natural world.
How interesting to read about Kropotkin, who had the independence of mind to go against the grain and emphasize the myriad examples of cooperation that abound in the natural world, and to point out how the ideas of his British colleagues in 1902 found their way into the literature of the age, justifying capitalists’ selfish ends. Geoff Olson is so right to bring this man’s ideas to light at this particular time in history, and to point out that cooperation is perhaps our only alternative to “mutual extermination.”
Bravo, once again, Geoff! You have a way of always hitting the nail on the head. Cheers and thanks.

Cath Morris

An open letter to
US President Bush
In case you missed last Friday’s Late Night With Bill Maher:
Mr. President, this job can’t be fun for you any more.
There’s no more money to spend – you used up all of that.
You can’t start another war because you used up the army.
And now, darn the luck, the rest of your term has become the Bush family nightmare: helping poor people.
Listen to your mom. The cupboard’s bare, the credit cards maxed out.
No one’s speaking to you. Mission accomplished.
Now it’s time to do what you’ve always done best: lose interest and walk away.
Like you did with your military service and the oil company and the baseball team. It’s time. Time to move on and try the next fantasy job.
How about cowboy or space man?
Now I know what you’re saying: there are so many other things that you as president could involve yourself in. Please don’t. I know, I know.
There’s a lot left to do.
There’s a war with Venezuela.
Eliminating the sales tax on yachts.
Turning the space program over to the church.
And social security to Fannie Mae. Giving embryos the vote.
But, Sir, none of that is going to happen now. Why?
Because you govern like Billy Joel drives.
You’ve performed so poorly.
I’m surprised that you haven’t given yourself a medal.
You’re a catastrophe that walks like a man.
Herbert Hoover was a shitty president, but even he never conceded an entire city to rising water and snakes.
On your watch, we’ve lost almost all of our allies, the surplus, four airliners, two trade centers, a piece of the Pentagon and the city of New Orleans.
Maybe you’re just not lucky.
I’m not saying you don’t love this country.
I’m just wondering how much worse it could be if you were on the other side.
So, yes, God does speak to you.
What he is saying is: “Take a hint.”
Move forward and look back
Many thanks to Celia Brauer for her well-researched and compelling argument for the return of salmon-bearing streams to Vancouver (Where Have All the Salmon Gone? September 2005). As more and more evidence shows, we must work to bring our city, and planet, back to nature. Sometimes, to progress, we must back up. Thank you.

Spencer Herbert, COPE candidate for parks board commissioner